Cutaneous lupus erythematosus. Diagnostic and therapeutic recommendations of the Polish Dermatological Society

Abstract

Lupus erythematosus is an autoimmune disease with complex and not fully elucidated pathogenic mechanisms, the most important of which is the presence of antibodies directed against the autoantigens, particularly located within the cell nucleus, which precede the development of clinical symptoms. Lupus erythematosus either affects only the skin or skin lesions are one of the manifestations of a systemic process. The classification is based on morphological, histopathological and serological features, and the course of the disease. Depending on diverse clinical manifestations and differences in prognosis, therapeutic management needs to be adapted to the individual patient. Therapeutic guidelines include both lifestyle modifications (photoprotection, avoidance of infections, stress factors, phototoxic and photoallergic drugs, and oestrogens; supplementation with Vitamin D), and topical (glucocorticosteroids, calcineurin inhibitors) and systemic medications. Antimalarials or systemic glucocorticosteroids are recommended in the treatment of patients with severe or disseminated lesions, with a tendency to scarring or a high risk of systemic organ involvement. Methotrexate, retinoids, sulphones and mycophenolate mofetil belong to second and third-line medications indicated for the treatment of cutaneous forms of lupus erythematosus.